Clin Exp Nephrol. 2019;23(12):1407-1417.

Ratio of triglyceride to high-density lipoprotein cholesterol and risk of major cardiovascular events in kidney transplant recipients.

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제1저자 김지은 · 교신저자 이하정

PMID 31468232 PMC6848440 DOI 10.1007/s10157-019-01776-9 IF 2.4 신장내과

소속 (7)

Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehakro, Jongno-gu, Seoul, 03080, South Korea.
Department of Internal Medicine, Hanyang University Guri Hospital, Guri, South Korea.
Department of Surgery, Seoul National University Transplantation Research Laboratory, Seoul National University Hospital, Seoul, South Korea.
Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea.
Kidney Research Institute, Seoul National University College of Medicine, Seoul, South Korea.
Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehakro, Jongno-gu, Seoul, 03080, South Korea. mdhjlee@gmail.com.
Kidney Research Institute, Seoul National University College of Medicine, Seoul, South Korea. mdhjlee@gmail.com.

Abstract

BACKGROUND Dyslipidemia is common in kidney transplant (KT) recipients. We analyzed the ratio of triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) in KT recipients to identify risk factors for major cardiovascular events (MACE).

METHODS We retrospectively included KT recipients with a lipid profile performed 1 year after transplantation. We classified patients according to the TG/HDL-C divided into quintiles. Subsequently, we analyzed the association between TG/HDL-C and MACE, defined as heart failure, coronary artery disease, and cerebrovascular disease confirmed by imaging studies.

RESULTS A total of 1301 KT recipients were enrolled. The median follow-up duration was 7.4 years (interquartile range 4.4-11.1 years). During the follow-up period, 80 (6.2%) patients developed MACE, which included 38 of unstable anginas, 9 of MIs, 19 of heart failures, 18 of cerebral infarcts, and 4 of cerebral hemorrhages. The fourth and fifth quintiles of TG/HDL-C showed a significantly increased risk of MACE [fourth quintile: adjusted hazard ratio (aHR), 3.38; 95% confidence interval (CI) 1.44-7.95; p = 0.005, fifth quintile: aHR, 2.67; 95% CI 1.13-6.30; p = 0.02]) compared to the second quintile of TG/HDL-C. This association is particularly evident in subgroups of non-DM, HTN, no history of CVD, and statin users.

CONCLUSIONS Higher TG/HDL-C levels may be associated with MACE risk in KT recipients.

Keywords

CardiovascularCholesterolKidney transplantationStatinsTG/HDL-C

Figures

**Fig. 1** The multivariate-adjusted restricted cubic spline analysis by lipid profiles on MACE risk. Total cholesterol (a), triglyceride (b), HDL-C (c), and TG/HDL-C (d) were analyzed by multivariate adjusted cox regression and plotted with spline curve. The bar plots showed the frequency of patients on each lipid profile value. The thick solid line showed hazard ratio and the dashed line represented 95% confidence interval. *HDL-C* high density lipoprotein cholesterol, *MACE* major adverse cardiovascular event, TC total cholesterol, TG triglyceride

**Fig. 2** Cumulative risk for MACE in the quintiles of TG/HDL-C. The second quintile (yellow line) showed lowest risk and the fourth and fifth quintiles (light blue and blue lines) showed a significantly elevated risk compared to the second quintile of TG/HDL-C (log rank p = 0.003 for the fourth quintile, p = 0.004 for the fifth quintile). Q1-5 in the legends represent each quintile of TG/HDL-C

**Fig. 3** Subgroup analysis for baseline characteristics and effect of TG/HDL-C on MACE risk. Based on the blue dotted line, the left side shows an increase in MACE risk at low TG/HDL-C (less than the second quintile) and the right side shows an increase in MACE risk at high TG/HDL-C (more than the second quintile). The red dotted line shows the overall effect on MACE with TG/HDL-C

그림 출처: PubMed Central 공개 논문 (PMC6848440)

Conflict of interest statement

The authors have no conflicts of interest to declare.

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